Method and apparatus for medical purposes



jui? 15,3941 R. F. JAMES ETAL I 2,249,610

METHOD AND APPARATUS PQR MEDICAL PURPOSES Filed June 1:5.,-1936 4sheets-speak 1 ATTORN July 15, 1941. R, `F, JAMES :TAL 2,249,610

METHOD AD APPARATUS FOR MEDICAL PURPOSES Filed June-13, .195e 4sheets-sheet 2y -ATTORN July 15 1941- R. F. v.lAMl-:ss 5ML y I 2,249,610

METHOD AND APPARATUS FOR MEDICAL PURPOSES y Filed June 15. 193e 4Sheets-sheet s za 1y a 'X "t u TT' fflfffrl -f- I 2000 2500A .3000 l55'00 4000 suffi/mph E56/0N off/fmfair Pyme-AM mea/mv 3 Fra/v new?amr/mf 1. daer/wy Z.

, July `15, 1941.

R. F. JAMES. ETAL METHOD AND APPARATUS FbR MEDICAL PURPosEs Filed June1s. 195s 4'sheets-sheet 4 Patented July 15,1941

METHonAND APrAnA'rUs Fon MEDICAL PURPOSES Robert F. James, Mahwah, N.J., and Deryl Hart,

Durham, N. C., assignors, by direct and mesne assignments, toWestinghouse Electric and Manufacturing Company, East Pittsburgh, Pa.,

a corporation of Pennsylvania Application June 13, 1936, Serial No.85,692

(Cl. 12B-396) -9 Claims.

'Ihis invention relates to the 4.science of medicine and surgery and ismore particularly concerned with minimizing the danger of infection fromorganisms transmitted through the air between patientand attendant orbetween patient and patient.

Despite the precautions ordinarily 'taken prior to and during the careand treatment of patients, in^many cases serious complications resultfrom infection of the patient. Heretofore the belief more generallyprevailed that infections resulted from skin' contamination orimproperly sterilized supplies in View of which the most drasticprecautions were observed in eliminating this,

source of infection.` For example, the time of sterilization wasincreased, the skin of the patient was most carefully washed with soapand water and then again washed with alcohol and ether and otherantiseptic solutions. However, such precautions have not eliminated thedanger of infection, as for example, during operations. It was felt thatthe cause of infection must lie somewhere else than on the supplies andupon roof of the building in which the rooms were ,located.

' These precautions, however, were not effective in materially reducingthe number f pathogenic organisms in the air which caus infection.Therefore, it was found necessary to investigate this matter further inorder to ascertain if the air was not impregnated with pathogenicorganisms from other sources.

It was suspected that the noses and throats l and possibly the skin ofthe individuals using the rooms were responsible for this contaminationofl the air. Cultures taken from the noses and 'throats of theseindividuals proved this to b e the fact and, therefore, as aprecautionary measure, the number of individuals entering the rooms wasreduced to a minimum. Masks were worn over the noses and mouths at alltimes, and all persistent carriers/of pathogenic bacteria, such forexample, as Staphylococcus aureus or streptococcus, were kept out of therooms at all times.

Although these precautions, together with the precautions previouslymentionedin connection with clean air and care of the room, reduced aircontamination by from to 80% nevertheless the number of organisms in theair were not reduced suiiiciently to eliminate all infections and it wasfound that in almost every infected case the organism cultured from aWound, for example, was identical with the culture from the air'- inthefroom.

Upon investigating this situation, it was quite definitely shown bynumerous culture tests that most of the infections were caused by thenemolytic Staphylococcus aureus, and that the organisms entered a wound,for example, from the air rather than from the skin of the patient, and

further that. the air was contaminated by the personnelentering the roomand also by the patients.

Particularly in surgical cases it was ascertained that, while infectionswith suppuration were rare, culture of the drainage tracts and incisionsshowed the presence of the hemolytic staphyloooccus aureus, or otherpathogenic bacteria, (as high as 33% -in thoracoplastics). Additionally-in such cases, all supplies and all procedures in operating roomtechnique were checked by cultures and found to be satisfactory exceptfor the air whichA was heavily contaminated. The Staphylococcus aureuswas usually present at times in large numbers. The operating roompersonnel and the general population were found at times to have theStaphylococcus aureus (frequently hemolytic) in the nose and throat inas high as 78% of cases and apparently they were the source of the aircontamination. As stated heretofore with all the precautions mentionedabove, it was not possible to reduce the number of organisms in the airsufficiently to eliminate all infections.

A/Inendeavoring to more precisely control this situation and eliminatethe danger. of infections from air-home pathogenic organisms, resort wasmade to the use of ultra-violet lights, such as commonly foundlupon themarket. In one of the it was demonstrated that a'sprayedcultureofhemolytic Staphylococcus aureus could be killed.

at a distance of eight feet from the lamp withinK sixty seconds. Thissterilization of the air was also attempted by means of a carbon arclamp,

but which had, apparently, no eifect on the organisms.

These sources of radiation, however, for many reasons were notsuitable'. for the purpose because of other unsatisfactory effects onthe patient. Inasmuch as the primary concern was the elimination fromthe air of the infection-causing organisms, so that such organisms wouldnot drop into an incision, for example, and cause infection; andsimultaneously therewith prevent any detrimental reactions in thepatient, a device was selected capable of emitting radiations whichkilled the objectionable organisms and which, at the same time, did notproduce any detrimental reactions in the patient. The radiation deviceused was of special design and provided a high intensity of radiationsin the region of 2500 A. u. wave band, together with a lesser intensityof radiations in the wave band region around and below 2000 A. u. with arelatively low intensity of radiations in the Wave lengths above 2600 A.u. It was found that by placing such devices in the form of a cluster ata distance of approximately six to eighteen inches above the operatingteams heads, for example, the radiations therefrom produced remarkableresults.

For example, in a hundred patients operated on under this cluster ofspecially designed and positioned radiation devices, it was found thatthe patients had no infected wounds; no wound cultures taken showed anygrowth; there was less temperature elevation during the post-operativecourse; the patients experienced less pain; and a smoother and morerapid convalescence was had by the patients.

found niet the wounds .hee1ed better than in the control animals.` Itwas further found that there was no increase in adhesions following anYexposure of the peritoneumto this radiation.

` granisms in the air coming from the noses and These operations wererun in parallel with a control group of cases and in all of the controlgroup it was found that in 5 to 35% of the cases infection had occurred;the' temperature during the post-operative course Awas much higher;thepatients experienced more pain; and the convalescence was not as smoothand rapid as was the case with the patients who were operated on whilethe devices were functioning to emit their radiations.

In the preliminary tests to determine the ability of these tubes toperform satisfactorily for the intended purpose, cultures of thehemolytic staphylocdccus aureus and a mixture of many organisms werefirst sprayed on culture plates and exposed to the radiations from thesedevices and it was found that the organisms were killed vat a distanceof ve feet from the devices within of the air was reduced by from 60 to90%. It ,was

also determined that the air in an entire room could not be completelysterilized with only eight of the devices, and that when the tubes wereturned oif re-contamination quickly occurred if people were present. v

'To determine that the radiations from these tubes would produce novdetrimental effects upon a patient, blonde individuals were subjected/to the radiations from eight devices for a periodof eighty minutes at adistance of five feet. Such individuals received only a slight reddeningof the area of the skin exposed to the radiations, this reddeningclearing up within twenty-foury hours.

Wounds in rats and dogs werel exposed to the 4 radiation from the eightdevices et e distance df five feet for from 30 to 90 minutes and it wasvthroats of the operating team together with those which might float infrom the surrounding air. The position of these lamps with respect tothe patient was such that the `more highly bactericidal radiationstherefrom were so absorbed by the intervening air as to be reduced to anegligible intensity. At the same time, the intensity of the radiationsin the region of the 2500 A. u. wave band, these also being bactericidalin character, was such as to project such radiations to the region orzone in the vicinity of the patient, thus destroying any pathogenicorganisms which might oat in from the surrounding air without l, passingthrough the zone of intense radiation inf the vicinity of the operatingteams heads.

Likewise the intensity of the radiations from the device in the regionabove 2600 A. u., that is in the so-called erythema regionn was soreduced in intensity that at the distance lthe device was placed abovethe patient, such radiations would not cause any detrimental reactionsin the patient. By thus controlling the lintensity and character of theradiations emanating from these devices, the air-borne organisms, whichwere concentrated in the region adjacent the throats and noses of theoperating team, were effectively destroyed and, at the saine time, thepathogenic organisms in the region adjacent the patient were likewisedestroyed. Since the radiations in this latter region were of suchcharacter and of' insuiiicient intensity to cause any detrimentalreaction upon the patient, no harm befell the patient. Such detrimentalreaction would be, for example, an irritation of the tissue such as aviolent reddening, blistering, or erythema of the skin with discomfortfollowing thereafter.

From the results obtained it is apparent that the intensity andcharacter of the radiations are such as to produce a beneficial reactionin the patient. Although it is not known precisely the mechanism bywhich this benecial reaction is produced, it is quite clear from theseresults that such a beneficial reaction was secured, as

all patients operated upon under the devices recovered more rapidly.experienced less pain and discomfort, and the incisions quickly healedwith freedom from infection.

In 'such operations known as thoracoplasties, many surgeons make theincision for the second operation approximately an inch from the firstscar because of the danger ofencountering a small focus of viableorganisms which might inoculate the new incision. When performing suchoperations under the radiation devices, it has been found that this oldtechnique may be altered by -making the second incision in the firstwithout danger of inoculation of the new incision. n

It is, therefore, an object of the invention to provide a method wherebya patient may be treated in such a manner and yunder suchconacter aroundthe patient as to be lethal to bac- ,teria and, non-injurious, andbenecial to thev devices in a series of cases where infection was od of-performing surgical operations by destroying air-borne organisms in andabout the patient lo during such operations by means of radiations inthat portion of the spectrum which is particularly lethal to suchorganisms.

Another object is to improve the method of performing surgicaloperations or treatments by immersing the patient and 'the attendants inpreselected radiations of such intensity and wave length as to be lethalto organisms coming within the sphere vof action of such radiations andwhich simultaneously therewith will not injure, but will produce insteada beneiicial action upon, the patient.

A more specific object of the invention is to perform surgicalvoperations or treatments upon a patient in a zone of radiations of suchintensity and character as to effectively destroy bacteria in thevicinityof the operating teams or attendants heads, and simultaneouslyprovide a zone of radiations of such intensity and charment of theradiation devices with respect toa patient vbeing operated upon and withrespect to the operating team; l

Fig. 2 is an elevation of the radiation device unit;

Fig. 3 is a bottom plan view of the radiation device unit;

Fig. 4 is a partial longitudinal sectional view of one of the radiationdevices;

Fig. 5 is a graph showing intensity of radiations as ordinates and Wave-lengths as abscissae;

Fig.y 6 illustrates culture plates showing the number of bacteriapresent inthe air with and without the radiation devices, said bacteriabeing obtained from the air within the region about eight feet from thepatient and at the same level;

Fig. 7 is a chart showing composite post-opera.- tive temperatures ofpatients operated upon with and without the use of the radiationdevices; and

Fig. 8 is a chart showing the time required for healing of the incisionsof patients operated upon with and without the use of the radiationpresent and where it was absent.

Referring to Fig. 1 of the drawings, radiation devices lll are arrangedin the form of a rectangular cluster 9 about a centrally-positionedillumination-furnishing source II, the cluster of radiation devicesbeing positioned approximately seven feet above the floor upon which theoperating table I2 stands. These radiation devices are mounted in aframe support sa, having elecmai contacts u for; engaging the endelectrical contacts I5 of the radiation devices for the purpose oi'supplying energy from I asource, such as a transformer I6 to theradiation devices. There are two radiationA deviceselectricallyconnected in series on each side of thevcluster and these devices arearranged so that the uppermost device is disposed inwardly from theother and toward the illumination source l Il, whereby each pair lies ina diagonal plane forming one of the sides oa pyramid with a square baseand a vertex directly above the light source Il, the devices do notshade one another in directing". the desired radiations diagonallydownward toward an operating area immediately below said light source,so that they converge at a central vertex above the level of thevpatient therebeneath. A transformer is provided for each two radiationdevices. The frame support is suitably wired to carry electrical currentfrom the transformer I6 to the electrical contacts I4 and is suspendedfrom a trolley block il, the latter being mounted for movement on a railIB. I

The position Aand arrangement ofv these radial The diameter of the glasstube is of importance since the current density of the dischargeproduced in the gaseous atmosphere within the tube I9 must be such thatthe proper intensity and character of radiations are emitted by thedevice so that the device operates with a temperature only a few degreesabove room temperature.

The gaseous atmosphere is carefully selected and comprises'a very smallquantity of mercury and a mixture 'of neon and argon in the proportionof 60' and 40% respectively, the pressure being -approximately 8 mm. ofmercury. The current density is approximately ma. per square inch. Y

The radiations emitted by the device, as stated heretofore, must be ofsuch intensity and wave length as to be lethal to bacteria and yet notharm the patient. It will thus be seen that the radiation generator, andparticularly each device l0 thereof, vmay be considered as emitting awedge of the ultra-violet radiations substantially restricted to apredetermined band, and of that the radiations are there weaker than atthe heads of the operating team, whereby they are of insuiiicientintensity to be harmful, said radiations, however, being of a characterand intensity to not only exert a bactericidal effect, but promotenatural healing of the incised tissue. The operation4 is performed whilethe radiations are being generated and the relative positions of theparticipants maintained. During saidA operation, air-borne organismsexhaled by the operating` team enter what might be considered as thefirst zone, or that near the ultra-violet radiation generator, and aredestroyed during their travel to what might be considered as the secondzone, or that adjacent the patient,

before reaching the incision.

or'toward the shorter wave lengths. Those in .the longer wave lengthband, i. e., those above 2600 A. u. are ordinarily used for producingerythema with pigmentation and oedema,. It is to be noted with respectto the latter that the intensities of these longer or erythemaradiations are relatively low compared'to the bactericidal radiationsaround 2500 A. u. and also that the radiations below 2500 A. u. arediminished in intensity as compared with those radiations around 2500 A.u.

Since the radiations above 2600 A. u. cause erythema with subsequentVpigmentation and oedema, it is obvious that since these are ofrelatively low intensity, very little harm can be expected in the way ofirritating the tissue of the patient.- The radiations below 2500 A. u.also, when of suicient intensity, produce an erythema, but of differentcharacter. In the former the skin becomes darkened in color andblisters, whereas in the latter the skin becomes reddened. Too much ofthe former energy is harmful and may cause the skin to blister withpossible disastrous results; hence the reason for diminishl ing theintensity of such radiations. At the same time, it is desirable to havea sufficiently high intensity of the shorter radiations which will beeffective to destroy bacteria within approximately a foot of theradiation device, which, together with the radiations around 2500 A. u.will effectively destroy the bacteria emanating from the noses andthroats of the operating team.

It is thus apparent that a zone of bactericidal radiations is createdand maintained about the operating teams heads. Simultaneously with suchaction the radiations with wave lengths around 2500 A. u. which are notreadily absorbed by the air, will be projected down to the zone orregion around the patient to effectively destroy any bacteria comingwithin this region. The shorter radiations, namely, those around 2000 A.u. are easily absorbedby the air, hence these shorter radiations do notreach the patient with sufllcient intensity to bring about thedestruction nique in operating may be altered with safety.

of the bacteria with sufllcient effectiveness in the period of time inwhich the operation is performed.

'I'he usual type ofV radiation sources now found on the market such, forexample. as the carbon arc, mercury quartz burner, etc., have a spectralenergy distribution of such a character that, in order to obtainsuilicient intensity of the bactericidal radiation to effectively killbacteria, too high an intensity of the longer wave lengths and -of thevery short bactericidal radiations is ob- 4being employed. In the lowerpair of plates of this figure the absence of such dots is plainlyevident, and since this plate was expsed u me air when the radiationdevices were functioning,

it is quite clear that the bacteria in the air were Referring to Fig. 5,there is illustrated theA destroyed, or their growth and multiplicationinhibited.

These culture plates were'made with an ope ating team present and are,Atherefore, truly representative of conditions as they actually exist.

The beneficial action upon the patient of the radiations emanating fromthese devices is depicted in Figs. 7 and 8. In Fig. '7 curve .A is acomposite temperature curve of nine patients following operationswithout the use of radiation devices, while the curve B is a compositetemperature curve of nine patients following the operations with theradiation devices functioning.

The benefit derived by the patient is quite evident since, in the lowergraph the temperature was lower, there was less infection and less dis'-comfort to the patient. It is quite evident that `in the nine operationsperformed under the radiations the post-operative temperature curve is,infection was detected and in other cases infection was present asindicated by the chart. It is quite evident that this period healing wasconsiderably shortened with the devices operating, thus benefiting thepatient. It was also observed that the incisions healed more rapidly inthose cases where the operations were performed with the radiationdevices in operation, the wounds healing per primum. Additionally.

there was no fluid from or sloughing of the inclsion, the incisionsrequiring no drains in the cases where the radiation devices wereemployed. Furthermore, all patients operated on under the radiationdevices convalesced more rapidly with considerably less discomfort andpain. Because of this rapid and clean healing of the incisions, it hasbeen found in performing such an operation known as thoracoplasty, thatthe usual tech- This new technique is the making of the second incisionin the first incision instead of removed therefrom as has been thepractice heretofore.

'I'hese remarkable results are attributable to the employment of thespecial radiation device arranged in such a manner as to create zones ofradiations, in the one of' which the bactericidal radiations areparticularly intensive and effective in destroying air-borne organismswhere most needed, and in the other of which the bactericidal action ofthe radiations a-re still present but in which the accompanyingradiations are so reduced in intensity as not to harm the patient.

Although the invention has been specifically described as relating tosurgical operations, it is within the purview of the invention tocontemplate all medlcal treatments where there is danger of infectionfrom air-borne organisms or where beneficial action upon the patient isdesired without any detrimental results occurring to the patient.

We claim:

1. An apparatus for preventing the infection of a patient by organismstransmitted by the air. while being operated upon or otherwise treated,

comprising in vcombination with an'operating ta- 'I ble'or othersupport, a cluster of radiation devices positioned above the tableorsupport at zone of bactericidal rays may be created'on and such adistance as to ood the patient and the operating team with bactericidalradiations, said devices having a radiation curve in which the intensityof the radiations of wave lengths around 2500 A. u.is predominant, ascompared with the radiations on either side of said wave lengths andbeing arranged in pairs to denne a relatively large area, the devices ofeach pair defining one of diagonal planes forming the sides of apyramid, thel vertex of which is centrally disposed above said cluster.

2. Irradiating apparatus for surgical use comprising a trolley blockmounted for movement on a rail, a transformer carried by said block,

foursupporting elements depending from said block, with theirintermediate portions braced witlrrespect to`one another, and theirlower portions ared downwardly and outwardly, a rectangular frame eachcorner of which connects with one of said depending elements and eachside of which carries a plurality of electrical contacts, radiationdevices comprising elongated tubes extending generally parallel to theelements forming the rectangular frame, so as to outline the areaenclosed thereby, and engaging said contacts, wiring between saidcontacts and transformer, whereby said radiation devices are operabletherefrom, and a source of illumination supported from said trolleyblock and disposed in said rectangular area.

3. In an operating room, apparatus mounted for movement over anoperating table, said apparatus comprising a movably mounted supportingelement, a transformer carried thereby, supporting rods depending fromsaid element, each of said rods extending downwardly' therefrom andIthen flaring diagonallyl outward, a straight sided frame having eachcorner connectedto one of said rods, each side of said .frame carryingcontacts, an elongated ultraviolet generator paralleling each side ofthe frame between said contacts, and means electrically connecting saidcontacts to said transformer.

4. Ultra-violet radiation generating apparatus adapted to be disposedabove a patient and about six to eighteen inches above the heads of anoperating team, said apparatus comprising a supporting element, rodsdepending therefrom, each of said rods having its lower portion flaringits corners connected to said rods, electrical contacts carried by saidframe, a pair of ultraviolet -generators paralleling eachA side of saidframe, and each comprising an elongated glass envelope adapted toefiiciently transmit ultraviolet light, said pairs lying in diagonalplanes, which extend substantially parallel to the diagonally extendingportions of the associated rods and merge at a central vertexthereabove, so as to, without interference, direct diagonal radiationson an operating area therebeneath, without danger of shadows frommembers of the operating team, each envelope yhaving a filling of neon,argon and mercury vapor at low pressure, said generators vbeing operableat such a potential around the patient, weaker on account of dispersionand air-absorption, but still effective to prevent wound infection andexert a beneficialv envelope adapted' to efficiently transmitultradiagonally outward, a straight sided frame having that a dischargeof'about one hundred and sixty `milliamperes per square inch occurs ineach envelope, with the generation. of ultra-violet,-

" heads of the operating team to effectively kill nose, throat and otherair-borne organisms above said patient during the operation, and anotherviolet light, at least some of said discharge tubes being arranged, endto end, to define arelatively large normally horizontal area, and alllying in diagonal planes Amerging at a central vertex thereabove, so asto without interference direct .created above 'the patient around theheads of the operating team to eiectively kill nose, throat and otherair-borne organisms above said patient V'during the'operation, andanother zone of bactericidal radiations may be created on, and in thehorizontal plane of, the patient, weaker on account of dispersion andair absorption, .but still effective to prevent wound infection andexert a beneficial action on healing. l

6. Ultra-violet radiation generating apparatus adapted tov be disposedabove the h eads of an operating team and a correspondingly greaterdistance above a patient being operated on by said team, comprising aplurality of ultra-violet ray generators each consisting of a glassenvelope adapted to eiiiciently transmit ultra-violet light, saidgenerators lying in diagonal planes merging at a central vertexthereabove so as to direct diagonal radiations on an operating areatherebeneath, each envelope having a rare gaseous filling admixed withmercury vapor at low pressure, and said generators being operable atsuch a potential that ultra-violet radiations predominantly in the bandbetween 2500 and 2600 A. u. with some radiations of wavelengths below v2500 A. u., are produced, whereby a zone of intense bactericidal rays iscreated adjacent the heads of the operating'team to effectively killair-borne organisms exhaled by said team above said patient during theoperation, and another -zone of bactericidal rays is created on andaround the patient, weaker .on account of dispersion' and airabsorption, but still effective to prevent wound infection and exert abeneficial action on healing.

7. Apparatus for supplying light and bactericidal radiations comprisinga frame support, a plurality of elongated tubular ultra-violet lightgenerating devices secured to thelower portion of said support, saiddevices being arranged to outline a relatively large area and disposedin pairs to define diagonal planes,l which planes merge at a centralvertex thereabove, so as to without interference direct diagonalradiations on an operating area therebeneath without danger of shadowsfrom members of an operating team. and an independent source of visiblelight disposed within said area.

8. Ultra-violet radiation generating apparatus adapted to be disposedabove the heads of anv operating team, and at a correspondingly greaterVdistance above a patient being operating on bvl said team', comprising aplurality of ultra-violet ray generators each consisting of a tubularglass envelope adapted to eiiiciently transmit ultraviolet light, saidgenera-tors outlining a relatively large area and arranged in pairsdening planes disposed so that the 'generators ofA said pairs directradiations, withoutv interference, diagonally downward, so that saiddirected radiations -converge at a central vertex above the level of thepatient therebeneath, each envelope having a rare gaseous fillingadmixed with mercury vapor at low pressure, and said generators beingoperable at such alpotential that ultra-violet radiations predominantlyin the band between 2500 and 2600 A. u. are produced, whereby saidconverging radiations forma beam which eectively kills air-borneorganisms exhaled by said team above said patient during the operation.

9. Ultra-violet radiations generating apparatus adapted to be disposedabove the heads of an operating team and at a correspondingly greaterdistance above a patient being operated on by said team, comprising aplurality of ultra-violet ray generators, said generators being paired,each consisting of a tubular glass envelope adapted to efiicientlytransmit ultra-violet light, said envelopes being positioned to deiine arelativelyl diations form a beam, which effectively kills airborneorganisms tending to impinge on the wound of the patient during saidoperation.

' i n ROBERT F. JAMES.

DERYL HART.

